How to Study

"I was playing mahjong in Inspector Chan’s villa. It was just after midnight when Ah-Dee rushed in and screamed ‘The Red Army is marching across the border!’ I almost wetted myself." recounted my mother many years later. Inspector Chan’s villa was a huge mansion a couple of miles south of the border between Hong Kong and Communist China. Ah-Dee was one of the many "horse-boys" (hangers-on) of the Chans. He was specifically instructed by Inspector Chan of the Hong Kong Police to convey this privileged information to his beloved fourth wife.

In an instant, my life was irreversibly changed. The Red Army didn’t come. But my parents had witnessed the atrocities committed by the Imperial Japanese Army. They didn’t want to take any chances with the Chinese People's Liberation Army. They phoned me and asked me to apply for landed immigrant status immediately. Thereafter, I could sponsor them and my two little brothers to come to Canada. "How can I go back to Hong Kong when my parents are coming over?" I thought. "I suppose I can go into general practice." However, it was very difficult for a new graduate to set up practice in a big city in Canada and I didn’t want to live in a small town. "How about going into Surgery?" After all, I was good with my hands. With my surgery rotation coming up, I decided to make my final decision after I had a glimpse of what life would be like as a surgeon.

Surgery usually began at 8:00 a.m. On the first day of my rotation, I went to the surgical ward at 7:00 a.m. in hopes of finishing rounds before going to the operating room. "Dr. Louie, why don’t you go to the lounge? Dr. Baskin and the other interns have finished rounds and are having coffee there." said the head nurse. The next morning, I went to the ward at 6:00 a.m. "Dr. Louie, why don’t you go to the lounge and make coffee? Dr. Baskin is finishing rounds. He will be writing progress notes in the lounge shortly." said the nurse. Dr. Baskin was the chief resident in General Surgery. He lived 2 miles outside of city limits. For him to finish rounds at six in the morning, he probably had to get up at 4:00 a.m. "Is this the kind of life I want to lead?" I asked myself.

"There is a three-year waiting list in our training program." said Dr. Ewen, head of the Radiology Department of the general hospital in Winnipeg. This hospital operated under the auspices of the University of Manitoba. It was looked upon as the pinnacle by the interns and residents. "Why don’t you try the hospital across the river?" he suggested. "We have received the reports on your performance." said Dr. Yenson, the head of Radiology of the hospital in the neighboring city. This hospital was considered to be run-of-the-mill by the interns. "Well. You were at the bottom of your class in medical school. Your performance as an intern is rated as poor in the interim report." he continued. "We can admit you into our program, but we’d have to put you on probation for one year."

Internship was over and I started training in Radiology. On the first day, a junior resident in Orthopedics walked into the department with an outside x-ray film of a recently admitted patient. It was the x-ray of an arm. There was obviously something wrong with the arm bone. "Anybody knows what this is?" Dr. Yenson asked of the new residents. "Fibrous dysplasia." someone answered loudly. "Fibrous what?" I questioned in my head. That disease was totally alien to me. As soon as I got home, I looked up the index of my Pathology text and flipped to the corresponding page. To my complete and utter horror, I had underlined every word in that chapter. I had even written "N.B." a couple of times next to the title. And, I couldn’t even remember the name of that disease. "This is unbelievable." I thought. "I have read this book from cover to cover." Although I did not do well academically in my first year residency, I was good in performing barium enemas. My probation was lifted.

Not long into my second year in Radiology, the faculty of the University of Manitoba decided to amalgamate the teaching programs of all of the hospitals in the province. The combined radiology program was headed by Dr. Ewen. "I know you are no longer on probation. However, you’re my responsibility now." said Dr. Ewen. "I don’t want you to spend 4 years in the program, and then find out that you are unable to pass the final exam. How much time do you spend on studying?" "I study 2 hours a day for 6 days a week. In addition to that, I spend 1 or 2 hours a week in the film library." I said. Dr. Ewen was not unhappy with this answer and I was not kicked out.

My third year was the "Outside Year". Residents were advised to take one year of training in any specialty other than the one they were enrolled in. Residents who had one outside year have consistently turned out to be more rounded and more knowledgeable than those who spent the entire 4 years in their own specialty. I knew I didn’t want to take surgery. I wanted to take something that I didn’t have to get out of bed at an ungodly hour.

Pathology seemed to fit the bill. My first assignment was to assist a pathologist to do an autopsy on a patient who died of kidney failure. "This patient had a biopsy several years ago. He was found to have amyloidosis." said Dr. Pennington, the head of the Pathology Department. "I want you to present this case at grand rounds [two weeks from now]. Review the literature and give a talk on amyloidosis." he continued. "I am looking forward to learn something from you."

"What? Learn something from me? Me?" I thought. Dr. Pennington was widely regarded as the most knowledgeable doctor in Winnipeg. He was also a well-known philanthropist in Manitoba. I didn’t want to disappoint him, so I embarked on an in-depth study on amyloidosis and a couple of related conditions. At grand rounds, I presented an exhaustive review of the disease. At the end of my presentation, the audience burst into thunderous applause.

Since then, I do not read text books from cover to cover anymore. Any topic I needed to know, I would read up on it in the utmost detail. I would also briefly look into the related topics. After studying for 24 years (including the year in Grade 1) and 3 years after getting an MD degree, I finally learned how to study. Since then, I used this method - which I called "Selective Immersion with Extension"- exclusively. In 2 years, I studied everything that I considered to be important in my specialty and reviewed almost all the subjects I was taught in the 3rd and 4th years of medical school. Essentially, I covered 6 years of material in 2 years. Because various topics in Medicine are inter-related, I became quite knowledgeable even on subjects that I had not selectively studied. Before the final exam and before I started looking for a job, I received job offers from Dr. Ewen and the radiologist-in-chief of a large teaching hospital in Edmonton.

As usual, the final examination consisted of two parts. In the written portion, I found my method was most suited for the multiple-choice questions, because I knew the details required to pick out the correct answers. In the oral exam, the first case involved a condition that I had "selectively immersed in". I delivered a detailed dissertation on that and the related diseases. Before I could put finishing touches on my discussion, 50 minutes had elapsed. One of the examiners said "Let’s go onto the next case. We have only 10 minutes left." The other examiner said "Let’s adjourn. I’ll give him an A+ even if he doesn’t say a word on the next case."

How good is this method for students studying other subjects? I don’t really know. However, if I were to study Inorganic Chemistry, I would study sodium really well and I would learn a little about potassium. Then, I would do the same for another element and another element. If I were to study Canadian Geography, I would study Manitoba in detail and learn something about Saskatchewan. Then, I would study the other provinces. I hope students without a good method of studying will find this story helpful.